Medicare Fraud Reports From the Office of Inspector General and Recent State Enforcement Actions

Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced last June a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulting in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings.

Editor's Note: We reported to Medicare double billings we had received for a service at a medical facility a couple of years ago. Medicare told us that they were going to report our experience as fraud. We felt that we should show you examples of State Enforcement Actions that take place continuously. In order to cut down on fraud cited by some members Congress as a reason to change, reduce or privatize the system, we have to carefully review what Medicare has paid and make sure there are no irregularities in payments to providers. Read carefully your Explanations of Benefits to find this kind of fraud and reduce costs.

Two Plead Guilty To Medicaid FraudSteven Platt, a North Carolina resident, entered a plea of guilty to two counts of Medicaid Fraud today in Dekalb County Superior Court. The Court sentenced Mr. Platt to serve 2 years in prison, followed by 12 years of probation, and restitution in the amount of $400,000.00.

Orange County Dentist Arrested for Defrauding Medicaid Out of More Than $5,500TALLAHASSEE, Fla.-Attorney General Pam Bondi's Medicaid Fraud Control Unit and the Altamonte Springs Police Department today arrested an Orange County dentist for allegedly defrauding the Florida Medicaid program. According to the investigation, Dr. Merys Downer-Garnette billed for services that were never rendered, not rendered as billed or double-billed, causing more than $5,500 in fraudulent claims to the state's Medicaid program.

September 24, 2015; Tennessee Department of Finance and Administration

September 18, 2015; Tennessee Department of Finance and Administration

Mississippi Woman Charged With TennCare FraudNASHVILLE, Tenn. - A Mississippi woman is charged with TennCare fraud and theft of property after she received healthcare insurance benefits through the state's healthcare insurance program, even though she was not eligible.

September 15, 2015; Tennessee Department of Finance and Administration

Two Plead Guilty to Medicaid FraudOn September 10th, 2015, Derrell Jackson and Shayla Darrington Jackson pled guilty to one count of Medicaid Fraud each. Gwinnett County Superior Court sentenced Derrell Jackson to ten years in jail which he is to serve three and the balance on probation. Shayla Jackson was sentenced to ten years but to serve two under a work release program. The court also ordered $605,000.00 in restitution.

Additional Golden Living nursing homes added to legal actionHARRISBURG - Attorney General Kathleen G. Kane today announced her office has filed an amended legal action against a chain of nursing home companies accused of misleading consumers by failing to provide basic services to elderly and vulnerable residents.

September 9, 2015; New York Attorney General

Westchester Transportation Company Owner Sentenced To Jail For Stealing Over $200k From MedicaidPEARL RIVER - Kurien Palliankal, 48, of Yonkers, owner of Carewell Ambulette, Inc., was sentenced in Westchester County Court today to six months in jail for stealing from Medicaid, Attorney General Eric T. Schneiderman announced. He also was sentenced to five years probation after he serves his jail sentence. The corporation, formerly based in New Rochelle, was also sentenced to pay a fine of $10,000.